RESUMEN
OBJECTIVE: We aimed to determine the reasons for irrational antibiotic use, to evaluate knowledge, attitudes, and behaviors of physicians regarding such use, to find factors affecting knowledge of physicians, and to explore precautions that need to be taken to stop irrational antibiotic use. MATERIAL AND METHODS: We performed the study between January 2014 and June 2014. We included 202 physicians who answered a questionnaire with 22 multiple-choice questions about knowledge (eight questions), behavior and attitudes of physicians (nine questions), and recommendations for reducing antibiotic consumption (five questions). Answers to all questions were assessed according to the physician's age, educational status, metropolitan areas, and healthcare facilities. RESULTS: The effects of parents' expectations and satisfaction (7.4%-40.0%) (P<0.0001) and socioeconomical status of families (33%-62%) (P=0.007) increased as the participants' age decreased. Participants working at public hospitals (42.6%) considered expectations and satisfaction of parents more important than other participants (10.5%-26.9%; P=0.002). Rapid recovery of patients was not an essential determinant for administering antibiotics for pediatricians (25.7%) and pediatric assistants (26.9%). However, it was important for emergency physicians (55.6%) and family physicians (60%, P=0.016). Physicians working at university hospitals did not consider this determinant as important as physicians working in other healthcare facilities (P=0.001). CONCLUSION: To determine the obstacles associated with promoting rational antibiotic usage, every country should assess the attitudes, behavior, and knowledge of physicians related to such use. The present study is one of the few in Turkey to address the problems associated with irrational antibiotic use.
Asunto(s)
Antibacterianos , Médicos , Antibacterianos/uso terapéutico , Niño , Conocimientos, Actitudes y Práctica en Salud , Humanos , Percepción , Pautas de la Práctica en Medicina , Encuestas y CuestionariosRESUMEN
Gastric emptying time (GET) appears to be a rate-limiting factor in the absorption of cyclosporine-A (CsA) and may be responsible for intra- and interpatient variability of CsA bioavailability. Few studies have assessed gastric motility after renal transplantation. The purpose of this study was to evaluate gastric emptying of semi-solid material in stable renal transplant patients with reference to blood CsA levels. The GET of semi-solids (GET t(1/2), half emptying time) was measured in 16 transplant recipients who were taking CsA (Neoral), prednisolone and azathioprine (or mycophenolate mofetil). The GET (t(1/2)) measured by radionuclide methods, was analyzed with reference to the daily CsA doses, levels of CsA (C(0)), and serum creatinine concentrations. The mean GET (t(1/2)) was 89.1 +/- 26.4 minutes. Twelve patients exhibited delayed gastric emptying with a mean CsA level of 171.8 +/- 56 ng/mL and a mean dose of 4.1 +/- 1.1 mg/kg/d. The GET (t(1/2)) was not significantly correlated with the serum creatinine levels, the time since transplantation, or the CsA concentration. In addition, the correlation between the mean daily CsA dose and the GET (t(1/2)) was only weakly positive, (r =.33, P =.2) and therefore, statistically insignificant. In conclusion, it could not be ascertained whether a higher dose of CsA delays gastric emptying or whether patients with delayed emptying require higher doses of CsA. However, it is believed that determining the GET after transplantation helps in the adjustment of immunosuppressant doses.
Asunto(s)
Ciclosporina/uso terapéutico , Vaciamiento Gástrico/efectos de los fármacos , Trasplante de Riñón/fisiología , Ácido Micofenólico/análogos & derivados , Adolescente , Adulto , Azatioprina/uso terapéutico , Niño , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Motilidad Gastrointestinal/efectos de los fármacos , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Masculino , Ácido Micofenólico/uso terapéutico , Prednisolona/uso terapéutico , Valores de Referencia , Factores de TiempoAsunto(s)
Tumor del Seno Endodérmico/complicaciones , Hiperpotasemia/etiología , Trombocitosis/inducido químicamente , Trombocitosis/complicaciones , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Diagnóstico Diferencial , Tumor del Seno Endodérmico/tratamiento farmacológico , Humanos , Hiperpotasemia/sangre , Hiperpotasemia/diagnóstico , Lactante , Pruebas de Función Renal , Masculino , Trombocitosis/sangreRESUMEN
Melatonin is a main neurohormone of the pineal gland. The effects of melatonin on the level of serum thyroid-stimulating hormone (TSH), thyroxine (T(4)), triiodothyronine (T(3)), nitrate, melatonin and liver superoxide dismutase (SOD) activity were examined in rats. Melatonin was injected at the dose of 10 mg/kg for 7 days, 2 h before turning the lights off. Rats were decapitated at 10:00 a.m. and 02:00 a.m., which are the times of the lowest and highest serum melatonin levels, respectively. Blood and tissue samples were collected. Decreased TSH, T(3), T(4) and nitrate levels were determined in the melatonin-injected and nighttime groups. Melatonin levels showed a diurnal rhythm. SOD activity increased in the melatonin-treated group. The results demonstrate that increased SOD activity, and reduced serum TSH, T(3), T(4) and nitrate levels correlated with the serum melatonin levels.
Asunto(s)
Antioxidantes/farmacología , Hígado/enzimología , Melatonina/farmacología , Nitratos/sangre , Superóxido Dismutasa/metabolismo , Hormonas Tiroideas/sangre , Animales , Activación Enzimática/efectos de los fármacos , Masculino , Melatonina/sangre , Ratas , Ratas Sprague-Dawley , Tirotropina/sangre , Tiroxina/sangre , Triyodotironina/sangreRESUMEN
A 12-year-old female patient with end-stage renal failure whose primary disease was reflux nephropathy, was first admitted for augmentation cystoplasty by using an ileum segment because of contracted urinary bladder. Four months later, she had a renal transplantation from her father on March 28th 1997. The first three days after the operation were uneventful. On the fourth day, she presented a severe rejection episode and was treated with steroid and ATG. A urinary fistula developed and she underwent surgery again on the 14th postoperative day. At surgery, apical resection + omentoplasty + nephrostomy + DJ replacement were performed. The postoperative period after the second operation was full of problems for both the patient and the transplantation team. She was discharged from hospital on the 40th postoperative day with excellent renal function (a serum creatinine level of 1 mg/dl) and with full recovery.
Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón , Complicaciones Posoperatorias , Niño , Femenino , Humanos , Vejiga Urinaria/cirugíaRESUMEN
The pathogenesis of Henoch-Schonlein Purpura (HSP) is still controversial. The aim of our study was to investigate the role of oxidative stress and cyclooxygenase (CO) pathway products in the pathogenesis of HSP. In order to investigate this, malondialdehyde (MDA) levels, indicating lipid peroxidation, prostaglandin E (PGE)-like activity as inflammatory mediator and vitamin E (vit-E) levels indicating anti-oxidant status were studied in a group of 10 children with HSP (five girls and five boys, aged 6-21 years, mean 10.7 years), both in the acute and recovery phase of the disease and in five age and sex-matched healthy children as a control group. The patients were also grouped into low and high clinical score groups. Plasma levels of MDA and PGE-like activity were significantly elevated in the active phase of HSP compared to the recovery phase. Vit-E levels were significantly reduced in the active phase compared to the recovery phase. The plasma levels of PGE-like activity of the patients obtained in the active phase were significantly higher than the levels of the control group, whereas the levels of the recovery phase were significantly lower than in the control group. No such difference between the controls and MDA and vit-E levels in the patient group was shown. No correlation between the clinical scores and the parameters studied could be found. Our findings indicate that oxidant stress and CO pathway products may play a role in the pathogenesis of HSP.
Asunto(s)
Vasculitis por IgA/etiología , Prostaglandinas/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Niño , Femenino , Humanos , Vasculitis por IgA/tratamiento farmacológico , Masculino , Malondialdehído/sangre , Estrés Oxidativo , Prostaglandina-Endoperóxido Sintasas/metabolismo , Prostaglandinas E/sangre , Resultado del Tratamiento , Vitamina E/sangreRESUMEN
OBJECTIVES: To compare the efficacy of desmopressin and indomethacin and also determine the prostaglandin E2 (PGE2) concentrations in the patient and control groups. METHODS: Eighty-five children with primary nocturnal enuresis were followed up for a baseline period of 4 weeks, during which they recorded wet and dry nights. After this period, the patients were divided into three groups that used desmopressin, indomethacin, or placebo for 4 weeks. The dosage of desmopressin (group A, n = 31 ) was 20 microg/day and the dosage of indomethacin (group B, n = 29) was 100 mg/day. The placebo group (group C) consisted of 25 patients. We determined the serum PGE2 and urine PGE2 concentrations before and after treatment in the three groups and in a control group. RESULTS: Treatment with desmopressin and indomethacin resulted in significantly more dry nights during the 4 weeks of observation than did placebo (P <0.005). The number of dry nights was also significantly different in the desmopressin group than in the indomethacin group (P <0.01). In the total patient group, the mean serum and urine PGE2 concentrations were significantly different from the control group's serum and urine PGE2 concentrations (P <0.001). There was a significant decrease in the serum and urine PGE2 concentrations in group A and group B after the treatment period (P <0.01). CONCLUSIONS: Desmopressin and indomethacin were found to be more effective than placebo. We conclude that prostaglandins have an important role in the pathophysiology of primary nocturnal enuresis.
Asunto(s)
Desamino Arginina Vasopresina/uso terapéutico , Dinoprostona/metabolismo , Enuresis/tratamiento farmacológico , Indometacina/uso terapéutico , Fármacos Renales/uso terapéutico , Adolescente , Niño , Enuresis/metabolismo , Estudios de Seguimiento , HumanosAsunto(s)
Anticuerpos Antivirales/sangre , Virus de la Hepatitis E/inmunología , Hepatitis E/diagnóstico , Fallo Renal Crónico/terapia , Diálisis Renal , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hepatitis E/epidemiología , Virus de la Hepatitis E/aislamiento & purificación , Humanos , Fallo Renal Crónico/virología , Masculino , Persona de Mediana Edad , Prevalencia , Valores de ReferenciaAsunto(s)
Aminoácidos Esenciales/sangre , Trastornos del Crecimiento/etiología , Trastornos del Crecimiento/metabolismo , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/análisis , Factor I del Crecimiento Similar a la Insulina/análisis , Fallo Renal Crónico/complicaciones , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , MasculinoAsunto(s)
Colelitiasis/etiología , Diálisis Renal/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
A 30 years old female patient, to whom a cadaveric kidney transplantation was performed 7 years earlier, presented severe hypertension attacks for 2 years. Renal artery stenosis diagnosed by angiography, PTA could not be performed. She underwent an operation for surgical correction of stenosis and successful internal iliac renal artery anastomosis performed by saphenous vein interposition. The patient was discharged at the fourteenth postoperative day with excellent kidney function and stable blood pressure.
Asunto(s)
Trasplante de Riñón , Arteria Renal/cirugía , Adulto , Anastomosis Quirúrgica , Femenino , Humanos , Hipertensión/etiología , Procedimientos de Cirugía Plástica , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/cirugíaRESUMEN
As urinary prostaglandin excretion might be involved in idiopathic hypercalciuria, we studied the excretion of prostaglandin E2 and calcium together with serum prostaglandin E2, parathormone and 1,25 dihydroxyvitamin D in 20 patients and 11 controls Idiopathic hypercalciuric patients showed increased levels of urinary prostaglandin E2-like activity, which is correlated with calcium excretion. Although no change was observed in serum parathormone level in control and hypercalciuric patients, there was a positive correlation between serum 1,25 dihydroxyvitamin D and prostaglandin E2-like activity. These findings suggest that prostaglandin E2 could play a role in the hypercalciuria syndrome, possibly by increasing 1,25 dihydroxyvitamin D synthesis.
Asunto(s)
Calcitriol/sangre , Calcio/orina , Dinoprostona/sangre , Dinoprostona/orina , Hormona Paratiroidea/sangre , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , SíndromeRESUMEN
Adhesion molecules play an important part in leucocyte transendothelial migration and thus may provide a useful marker of surface expression at inflammatory sites. In 20 patients with Henoch-Schönlein purpura serum intercellular adhesion molecule 1 (ICAM-1), E-selectin, and plasma von Willebrand factor (vWF) were determined by ELISA during the active and inactive phase of the disease. Twelve healthy children were studied as a control group. Serum ICAM-1 concentrations increased during the active phase of the disease and differed significantly compared with the inactive phase (p < 0.05). However ICAM-1 in the active phase did not differ significantly compared with controls (p = 0.08). Serum E-selectin concentrations did not differ in the active and inactive phase of the disease. By contrast, vWF increased in the active phase of the disease and differed significantly compared with inactive disease and control groups (p < 0.01). Considering the adhesion molecules and vWF, only vWF correlated well with the C reactive protein measurement in the active phase, which is considered a good marker of disease activity. These data suggest that plasma vWF is a good marker of vascular inflammation and endothelial damage. Circulating ICAM-1 might be an additional parameter in some of the patients.
Asunto(s)
Selectina E/sangre , Vasculitis por IgA/sangre , Molécula 1 de Adhesión Intercelular/sangre , Factor de von Willebrand/análisis , Adolescente , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Niño , Preescolar , Femenino , Hemorragia Gastrointestinal/sangre , Hematuria/sangre , Humanos , Masculino , Proteinuria/sangreRESUMEN
Serum levels of carboxyterminal propeptide of type I procollagen (PICP) and aminoterminal propeptide of type III procollagen (PIIINP) can be used as markers of bone formation and the evaluation of children with growth disorders. We measured the serum levels of these collagens by radioimmunoassay (RIA), insulin-like growth factor I (IGF-I) (by immunoradiometric assay) and insulin-like growth factor binding protein-3 (IGFBP-3) (by RIA) levels in 24 children aged between 4 and 14 years with chronic renal failure (CRF) (n = 12 dialysis, n = 12 non-dialysis) and 12 age-matched healthy controls, to find out whether these parameters have a prognostic or therapeutic value on monitoring of growth retardation in CRF. Mean serum IGFBP-3 and PIIINP levels in the dialysis patients were higher than the control group, the difference between the groups was statistically significant (P < 0.05). It seemed that the pubertal stage of the patients did not affect the levels of PICP, PIIINP, and IGFBP-3 while serum IGF-I levels in pubertal patients were significantly higher than those in prepubertal patients (P < 0.001). There was no significant correlation between PICP and PIIINP in any patients. Neither PICP nor PIIINP correlated with height z-score, bone age, IGF-I, or IGFBP-3. It was concluded that the increased serum IGFBP-3 and PIIINP levels in chronic renal disease are poor prognostic indicators leading to progressive renal failure and end-stage renal disease (ESRD). Further investigations into the effects of these collagens on growth failure associated with CRF are needed.
Asunto(s)
Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/análisis , Factor II del Crecimiento Similar a la Insulina/análisis , Fallo Renal Crónico/sangre , Procolágeno/análisis , Adolescente , Análisis de Varianza , Biomarcadores/análisis , Niño , Preescolar , Femenino , Trastornos del Crecimiento/sangre , Trastornos del Crecimiento/complicaciones , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Pronóstico , Radioinmunoensayo , Valores de ReferenciaRESUMEN
An experience with 103 children treated with extracorporeal shock wave lithotripsy (ESWL) is reviewed in this report. The success rate was 63%. The stone volume was of major importance for the result. There was a continuous decrease in success rate with increasing stone size. It was also shown that stone-free rates decreased with an increasing number of stones. Short-term complications were minor and hospitalization times were short. It is concluded that ESWL is a first-choice treatment in children with urinary calculi smaller than 200 mm2 in size.
Asunto(s)
Litotricia , Cálculos Urinarios/terapia , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
Serum levels of carboxyterminal propeptide of type I procollagen (PICP) and aminoterminal propeptide of type III procollagen (PIIINP) can be used as markers of bone formation and the evaluation of children with growth disorders. We measured the serum levels of these collagens with radioimmunoassay in 24 children aged between 4 and 14 years with chronic renal failure (CRF; n = 12 dialysis, n = 12 nondialysis) and 12 age-matched healthy controls, to find out whether these parameters have a prognostic or therapeutic value in monitoring the growth retardation in CRF. Mean serum PIIINP levels in the dialysis patients were higher than in the control group; the difference between the groups was statistically significant (p < 0.05). It seemed that the pubertal stage of the patients did not affect the levels of PICP and PIIINP. There was no significant correlation between PICP and PIIINP in any patients. Neither PICP nor PIIINP correlated with the height z-score or bone age. It was concluded that the increased serum PIIINP levels in renal patients might be accepted as a poor prognostic factor leading to progressive renal failure and end-stage renal disease. Further investigations into the effects of these collagens on growth failure associated with CRF are needed.
Asunto(s)
Fallo Renal Crónico/sangre , Procolágeno/sangre , Adolescente , Biomarcadores/sangre , Estatura , Desarrollo Óseo/fisiología , Niño , Preescolar , Femenino , Trastornos del Crecimiento/diagnóstico , Humanos , Fallo Renal Crónico/terapia , Masculino , Radioinmunoensayo , Diálisis RenalRESUMEN
Nephrotoxicity is a common side effect of intravascular contrast media (CM). Although nephrotoxicity of ionic CM has been widely demonstrated, recent studies suggest that newer and more costly non-ionic agents are not less nephrotoxic. We studied the hemodynamic, hematologic and nephrotoxic effects of CM prospectively in 38 patients (ages six months-16 years) with or without risk factors predisposing to nephropathy and compared ionic and non-ionic CM. We performed intravenous urography (IU) with a ionic CM, sodium meglumine diatrizoate (n = 18) and a non-ionic CM, iohexol (n = 20). The patients were divided into three groups according to glomerular filtration rate (GFR) [GFR < or = 50 (n = 9), 50-80 (n = 13), > or = 80 ml/min/1.732 (n = 26)]. Eleven patients had risk factors for nephropathy. Blood pressure, heart rate, ECG, urine and blood samples were obtained 24 hours and one hour before as well as one, 24, and 48 hours after CM infusion. Although a significant increase was found in urine specific gravity, protein/creatinine ratios and serum Na and creatinine levels, the increased levels were within normal limits. We observed a significant reduction in Hb and Htc and urinary prostaglandin E1 levels. Many of the changes observed in the urine and serum values after the use of CM were minor, insignificant and transient, later returning to their initial values. The GFR levels, the presence of risk factors and the use of ionic vs. non-ionic CM had no effect on the results. The elevated urinary basal beta-2-microglobulin levels further increased after CM in patients with low GFRs. It was concluded that non-ionic CM was not superior to ionic CM in patients with GFRs greater than 50 ml/min regardless of predisposing risk factors. One of the non-invasive radiological methods is advised instead of IU in patients with low GFRs.
Asunto(s)
Medios de Contraste/farmacología , Diatrizoato de Meglumina/farmacología , Yohexol/farmacología , Riñón/efectos de los fármacos , Urografía , Adolescente , Análisis de Varianza , Niño , Preescolar , Medios de Contraste/efectos adversos , Diatrizoato de Meglumina/efectos adversos , Tasa de Filtración Glomerular , Humanos , Lactante , Yohexol/efectos adversos , Estudios Prospectivos , Factores de Riesgo , Estadísticas no ParamétricasRESUMEN
The significance of serum insulin-like growth factor I (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3) levels in uremia is still controversial. In this study we measured serum IGF-I by immunoradiometric assay (IRMA) and IGFBP-3 levels by specific radioimmunoassay (RIA) in 28 children (aged 3-16 years) with end-stage (n = 14, on hemodialysis) and pre-terminal renal failure (n = 14) and in 15 age-matched healthy children. Thyroid function of the patients was also investigated and GH-stimulation tests with L-Dopa and insulin were performed. Neither IGF-I nor IGFBP-3 levels significantly correlated with mean height SDS for bone age or for chronological age in either non dialysis patients or pubertal (n = 10) or prepubertal patients (n = 18). These data was consistent with the concept that growth in CRF was not related to abnormalities in serum IGF-I or IGFBP-3 levels.
Asunto(s)
Proteínas Portadoras/sangre , Factor I del Crecimiento Similar a la Insulina/metabolismo , Fallo Renal Crónico/sangre , Adolescente , Niño , Preescolar , Femenino , Trastornos del Crecimiento/etiología , Humanos , Ensayo Inmunorradiométrico , Insulina , Proteínas de Unión a Factor de Crecimiento Similar a la Insulina , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/fisiopatología , Levodopa , Masculino , Radioinmunoensayo , Diálisis Renal , Glándula Tiroides/fisiopatologíaRESUMEN
We evaluated the efficacy of intestinal sonography in the diagnosis of gastrointestinal involvement of Henoch-Schönlein syndrome (HSS). Intestinal sonography was performed in 20 children who were clinically diagnosed as HSS and sonographic findings of the intestinal system were reviewed. Out of 20 patients, 10 who suffered from abdominal pain demonstrated sonographic findings consistent with small intestinal involvement (dilatation of intestinal segments, hypomotility, and eccentric thickening of the intestinal wall). Our results reveal that sonography of the intestine may be useful in the evaluation of the involvement of HSS.